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Lymphoedema specialists embedded into community nurse and wound services: impacts and outcomes

18 April 2024
Volume 33 · Issue 8



Lymphoedema is a progressive condition causing significant alterations to life, exerting pressures on unscheduled care from complications including cellulitis and wounds. An on the ground education programme (OGEP) was implemented to raise knowledge, competence and confidence in lymphoedema management in community clinical services. The aim of this study was to explore the impact and outcomes of the OGEP intervention.


Data were captured before and after OGEP on 561 lymphoedema patients in the community setting. Data recorded included resource use, costs and outcomes (EQ-5D-5L and LYMPROM).


Data demonstrated statistically significant reductions in resource allocations including staff visits (P<0.001), cellulitis admissions (P<0.001), compression consumables and wound dressing costs (P<0.001). Overall, the total mean per patient cost decreased from £1457.10 to £964.40 (including intervention) with outcomes significantly improved in EQ-5D-5L/LYMPROM scores.


The analysis suggests the OGEP intervention may offer reductions in resource costs and improvements in patient outcomes. OGEP may therefore provide an innovative solution in future care delivery.

Lymphoedema is a chronic and potentially progressive condition causing an excess accumulation of protein-rich fluid within the subcutaneous tissues that the lymphatic system has failed to remove (Mortimer, 2018). Lymphoedema can be categorised into primary or secondary. Primary lymphoedema is due to an abnormal genetic or lymphatic development, whereas secondary lymphoedema may be due to damage to the lymphatic system from cancer, skin disorders, venous disease, obesity or trauma (Moffatt et al, 2017; Holloway, 2018; Lindsay, 2019). The impact of lymphoedema predictably also affects quality of life (QoL) extending into all aspects of daily life including but not limited to mobility, relationships, shopping, social activities and the ability to work (Moffatt et al, 2017; Mortimer, 2018; Thomas et al, 2020; Gabe-Walters and Thomas, 2021). Those affected may experience pain, recurrent cellulitis (skin infection), immobility and heaviness in the affected area (Moffatt et al, 2017; Mortimer, 2018). Lymphoedema affects up to 29 per 1000 people in those aged 85 or over, lowering to a crude prevalence of 4 per 1000 (Moffatt et al, 2017), presenting a major clinical problem worldwide affecting at least 200 million people globally (Torgbenu at al, 2023). A collaborative approach from academic researchers and clinicians is underway, seeking to increase visibility, clinical prioritisation and funding for this burdensome health condition (Moffatt et al, 2019). Untreated lymphoedema can lead to chronic and difficult to treat wounds that are incredibly costly for healthcare systems, as well as recurring cellulitis possibly necessitating long-term antibiotic therapy or hospital admissions (Burian et al, 2021) creating a potentially preventable economic burden (Phillips et al, 2016; Guest et al, 2020).

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